| NPI | 1679965875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 297134) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: CA 297134) |
| 2251S0007X Physical Therapist, Sports (Licence: CA 297134) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 297134) | |
| 225200000X Physical Therapy Assistant (Licence: CA 10010) | |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2021-06-24 |